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year 5 cap > Elderly care > Flashcards

Elderly care Flashcards

1
Q

Deficiency In B12 Results in what type of anaemia

A

Macrocyctic

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2
Q

Comment on this chest x-ray

A

Anterior posterior chest x-ray = hard to comment on any cardiomegaly
Multiple pleural plaques (calcified)
Sternotomy suture can be noted

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3
Q

Especially if they involve the diaphragmatic pleura

Multiple Bilateral Calcified pleural Plaques Indicate What exposure.

A

Asbestos exposure

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4
Q

Incidental findings of non-symptomatic pleural plaques require treatment?

A

Not really, no Follow-up needed unless the patient becomes symptomatic

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5
Q

Not COPD

The spectrum of asbestos-related thoracic disease include:

A
  • Benign pleural effusion
  • Pleural plaques
  • Diffuse pleural thickening
  • Atelectasis
  • Asbestosis
  • Mesothelioma
  • Lung cancer
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6
Q

In women presenting with frailty fractures what is the age cut-off between further testing needed versus presumed osteoporosis

A

75

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7
Q

In a woman presenting with a Frailty fractureb Under the age of 75 What further investigations are indicated?

A

DEXA scan + calcium and vitamin D bloods

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8
Q

What is the T score needed to diagnose osteoporosis

A

-2.5

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9
Q

A patient post DEXA scanAs indicated to have mineral density suggestive of severe osteoporosis what additional investigations should be done

/Could be done

A
  • Calcium + vitamin D
  • Parathyroid hormone + thyroid
  • Bone turnover markers

A myeloma screen (urine and plasma electrophoresis), immunoglobulins and liver function tests would be additional tests to consider

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10
Q

What are some important considerations when starting on alendronic acid

A
  • Only taken once a week
  • Contraindicated in peptic ulceration/significant swallowing difficulties

Taken 30 minutes before breakfast with a full glass of water and remaining upright/standing 30 minutes

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11
Q

For patients who are unable to swallow alendronic acid what is NICEs recommended alternative

A

Denosumab

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12
Q

What is the single best means of Distinguishing between delirium And pre-existing dimension

A

Collateral history from relatives

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13
Q

The PINCH ME pneumonic is useful for identifying causes of delirium.What are these causes?

Everyone loves a pneumonic (This one is a bad one)

A
  • Pain
  • INfection
  • Constipation
  • DeHydration
  • Medication
  • Environment
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14
Q

Is low lighting helpful in delirium

A

Not exactly, while it may seem soothing it can cause shadows which can be miss perceived

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15
Q

What would be first-line Drug treatment in managing a patient with delirium

A

Low dose lorazepam (0.55 mg orally)

Drug treatment should Always be a last resort

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16
Q

What would be first-line Drug treatment in managing a patient with delirium

A

Low dose lorazepam (0.55 mg orally)

Drug treatment should Always be a last resort

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17
Q

Salbutamol can cause what electrolyte imbalance

A

Hypokalaemia

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18
Q

Hyperparathyroidism does what you Serum calcium

A

Hypercalcaemia

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19
Q

Aminobisphosphonate =

A

Alendronic acid

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20
Q

What is the therapeutic concentration of Digoxin

A

1 to 2 Micrograms/mL

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21
Q

What are some common symptoms of digoxin toxicity

A
  • Nausea and vomiting
  • Diarrhoea
  • Hallucinations
  • Visual disturbance
  • Drowsiness
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22
Q

What is important to consider when prescribing erythromycinIn a patient on Digitoxin

A

Erythromycin is a very potent hepatic enzyme inhibitor and will inhibit the metabolism of many drugs, This can result digoxin toxicity

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23
Q

Mechanism of action of warfarin?

A

It acts by antagonising the effects of Vitamin K

24
Q

Prevention of DVT/PE and surgical patients is done how pharmacologically

A

Usually low molecular weight heparin e.g. Enoxaparin tinzaparin
At prophylactic dose

25
Q

What Coagulation pathway does Warfarin effect

A

Extrinsic

26
Q

What is the recommended INR range for prevention of strokeIn patients with AF patients who have already suffered a stroke?

A

2-3

27
Q

Patients who have had prosthetic heart valve replacements are at higher risk of VTE; therefore, the recommended INR range in this population is usually?

A

3-4

28
Q

As warfarin contraindicated In a patient who has a history of falls

A

Not exactly, nice recommends to use The HAS-BLED tool to identify those at high risk of bleeding

29
Q

How does Cranberry juice affect warfarin

A

It has been found to enhance the effects therefore increasing INR

30
Q

Delirium is the syndrome characterised by

A

an acute confusion state associated with marked fluctuations in orientation and conscious level, including periods of lucidity.

31
Q

A Total Anterior Circulation Stroke syndrome requires all three of the following to be present:

A
  1. Unilateral weakness (and/or sensory deficit) of face arm and leg
  2. Homonymous hemianopia
  3. Highest Cerebral dysfunction (Dysphasia, visuospatial disorder)
32
Q

The most common site of occlusion for an TACI is the

A

Middle cerebral artery

33
Q

Anterior Circulation Infarcts are much less common than either MCA or Posterior occlusions(True or false)

A

True

34
Q

Advice for acute management of ischaemic strokes With acute hypertension is generally to avoid treating hypertension, what are the exceptions to this?

A

When there is:
* Hypertensive encephalopathy
* Hypertensive neuropathy
* Hypertensive cardiac failure
* Aortic dissection
* Preeclampsia/Eclampsia

35
Q

Polypharmacy is an important risk factor for falls and should be considered in all patients prescribed more than How may medications?

A

4

36
Q

How can citalopram cause hyponatraemia

A

Citalopram is an SSRI, these can cause syndrome of inappropriate secretion of antidiuretic Hormone and Subsequently cause hyponatraemia

37
Q

In a adult over the age of 55 the most appropriate first-line antihypertensive would be a calcium channel blocker (or thiazide diuretic) however is this still the case in a type II diabetic?

A

A ACE inhibitor would be preferred here

38
Q

In a adult over the age of 55 the most appropriate first-line antihypertensive would be a calcium channel blocker (or thiazide diuretic) however is this still the case in a type II diabetic?

A

A ACE inhibitor would be preferred here

39
Q

Recurrent laryngeal nerve palsy Can present with

A

A horse/weak voice

40
Q

Superior vena cava obstruction Can present with

A
  • Swollen plethoric face and neck
  • Distended neck veins + chest Veins
  • Elevated JVP (absent Pulsation)
  • Headaches
41
Q

Horner’s syndrome can present with

A
  • Miosis (pupil constriction)
  • enophthalmos (Sunken eyes)
  • Ptosis
  • Ipsilateral anhydrousis
42
Q

Primary lung tumours can metastasise to:

A
  • Bone
  • Brain
  • Liver
  • Adrenals
43
Q

Eton lambert syndrome typically occurs in association with

A

Small-cell lung cancer

44
Q

Eton lambert syndrome affects

A

Muscle fatigability of the proximal limbs and trunk.
Autonomic involvement is common = dry mouth, hyperreflexia.
Repeated muscle contractions lead to increased strength and reflexes (unlike myasthenic syndrome

It is associated with small-cell lung cancer

(Rarely eyes)

It is the pre synaptic membrane that is affected (unlike myasthenia)

45
Q

Describe a classic presentation of HHS

hyperosmolar hyperglycaemic state

A
  • Elderly patientWith type II diabetes (possibly undiagnosed)
  • Unwell for about a week
  • Marked dehydration
  • glucose of >35mM

Acidosis is absent as there has been no switch to ketone metabolism.

46
Q

What is the most important element of treating HHS

hyperosmolar hyperglycaemic state

A

Rehydration (probably intravenous)

Once hydration has begun may require only small doses of insulin

atients may have lost 8-10 litre of fluid

47
Q

A postitive postural BP test is said to occur when there is:

A
  • A drop in systolic BP of 20mmHg or more (with or without symptoms).
  • A drop to below 90mmHg on standing even if the drop is less than 20mmHg(With or without symptoms)
  • A drop in diastolic BP of 10mmHg with symptoms
48
Q

What other two agents (first-line and last line) used to treat postural hypertension

A
  1. Fludrocortisone
  2. Midodrine
49
Q

Some investigations are always performed routinely in patients with confusion.In BSUH it is called Geriatric Admission Profile (GAPS) and includes:

A
  • U&E,
  • FBC
  • LFT
  • glucose
  • CRP
  • calcium
  • B12 & folate
  • ferritin, iron and transferrin
  • TFT
  • vitamin D
50
Q

Subdural haematomas appear How on CT?

A

concave medially, this means that they appear as a crescent shaped pool of blood between the skull and the brain tissue

51
Q

What does this show

A

Right-sided mixed density subdural haematoma

52
Q

Subdural bleeding and rebleeding is usually due to damage which structures

A

tearing of fragile, bridging subdural veins (not arteries).

53
Q

‘Osborn’ or ‘J’ waves can occur in ?

A

Hypothermia

54
Q

Why is it important to re-warm elderly patient slowly who have hypothermia?

A

rapid rewarming may cause vasodilatation → shock → death.

rate of re-warming is between 0.5-2 degrees per hour

55
Q

alopecia areata, myxoedema and erythema ab igne are all associated with?

A

hypothyroidism

56
Q

Vitiligo appears as?

A

hypopigmented patches, sometimes with hyperpigmented borders. It is associated with autoimmune disorders.

year 5 cap (5 decks)

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